Objectives We sought to determine if and to what extent a woman’s exposure to stressful life events prior to conception (PSLEs) were associated with subsequent infant birth weight by using a nationally representative sample of US women. Methods We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study-Birth Cohort in 2001. Weighted regressions estimated the effect of exposure on very low and low birth weight, adjusting for maternal sociodemographic and health factors and stress during pregnancy. Results Twenty percent of women experienced any PSLE. In adjusted analyses, exposed women were 38% more likely to have a very low birth weight infant than nonexposed women. Furthermore, the accumulation of PSLEs was associated with reduced infant birth weight. Conclusions This was the first nationally representative study to our knowledge to investigate the impact of PSLEs on very low and low birth weight in the United States. Interventions aimed to improve birth outcomes will need to shift the clinical practice paradigm upstream to the preconception period to reduce women’s exposure to stress over the life course and improve the long-term health of children.

Objectives We determined whether and to what extent a woman’s exposure to stressful life events prior to conception (PSLEs) was associated with preterm birth and whether maternal age modified this relationship. Methods We examined 9350 mothers and infants participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative sample of US women and children born in 2001, to investigate the impact of PSLEs on preterm birth in the United States. We estimated the effect of exposure on preterm birth with weighted logistic regression, adjusting for maternal sociodemographic and health factors and stress during pregnancy. Results Of the women examined, 10.9% had a preterm birth. In adjusted analyses, women aged 15 to 19 years who experienced any PSLE had over a 4-fold increased risk for having a preterm birth. This association differed on the basis of the timing of the PSLE. Conclusions Findings suggest that adolescence may be a sensitive period for the risk of preterm birth among adolescents exposed to PSLEs. Clinical, programmatic, and policy interventions should address upstream PSLEs, especially for adolescents, to reduce the prevalence of preterm birth and improve maternal and child health.

Objectives This study takes a lifecourse approach to understanding the factors contributing to delivery methods in the United States by identifying preconception and pregnancy-related determinants of medically indicated and non-medically indicated Cesarean section (C-section). Methods Data are from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative, population-based survey of women delivering a live baby in 2001 (n=9,350). Three delivery methods were examined: (1) vaginal delivery (reference); (2) medically indicated C-section; and (3) non-medically indicated C-section. Using multinomial logistic regression, we examined the role of sociodemographics, health, healthcare, stressful life events, pregnancy complications, and history of C-section on the odds of medically indicated and non-medically indicated C-section, compared to vaginal delivery. Results 74.2% of women had a vaginal delivery, 11.6% had a non-medically indicated C-section, and 14.2% had a medically indicated C-section. Multivariable analyses revealed that prior C-section was the strongest predictor of both medically indicated and non-medically indicated C-sections. However, we find salient differences between the risk factors for indicated and non-indicated C-sections. Conclusions Surgical deliveries continue to occur at a high rate in the United States despite evidence that they increase the risk for morbidity and mortality among women and their children. Reducing the number of non-medically indicated C-sections is warranted to lower the short and long-term risks for deleterious health outcomes for women and their babies across the lifecourse. Healthcare providers should address the risk factors for medically indicated C-sections to optimize low-risk delivery methods and improve the survival, health, and well-being of children and their mothers.

Background The aim of this study was to estimate the cost-effectiveness of injectable extended release naltrexone (XR-NTX) compared to methadone maintenance and buprenorphine maintenance treatment (MMT and BMT respectively) for adult males enrolled in treatment for opioid dependence in the United States from the perspective of state-level addiction treatment payers. Methods We used a Markov model with daily time cycles to estimate the incremental cost per opioid-free day in a simulated cohort of adult males ages 18–65 over a six-month period from the state health program perspective. Results XR-NTX is predicted to be more effective and more costly than methadone or buprenorphine in our target population, with an incremental cost per opioid-free day gained relative to the next-most effective treatment (MMT) of $72. The cost-effectiveness of XR-NTX relative to MMT was driven by its effectiveness in deterring opioid use while receiving treatment. Conclusions XR-NTX is a cost-effective medication for treating opioid dependence if state addiction treatment payers are willing to pay at least $72 per opioid-free day.

Background The lifecourse perspective suggests a pathway may exist among maternal exposure to stressful life events prior to conception (PSLEs), infant birthweight, and subsequent offspring health, whereby PLSEs are part of a “chains-of-risk” that set children on a certain health pathway. No prior study has examined the link between PSLEs and offspring health in a nationally-representative sample of US mothers and their children. We used longitudinal, nationally-representative data to evaluate the relation between maternal exposure to PSLEs and subsequent measures of infant and toddler health, taking both maternal and obstetric characteristics into account. Methods We examined 6,900 mother-child dyads participating in two waves of the nationally-representative Early Childhood Longitudinal Study-Birth Cohort (n=6,900). Infant and toddler health outcomes assessed at 9 and 24 months included overall health status, special health care needs, and severe health conditions. Adjusted path analyses examined associations between PSLEs, birthweight, and child health outcomes. Results In adjusted analyses, PSLEs increased the risk for very low birthweight (VLBW, <1,500 grams), which, in turn, predicted poor health at both 9 and 24 months of age. Path analyses demonstrated that PSLEs had small indirect effects on children’s subsequent health that operated through VLBW. Conclusion Our analysis suggests a chains-of-risk model in which women’s exposure to PSLEs increases the risk for giving birth to a VLBW infant, which, in turn, adversely affects infant and toddler health. Addressing women’s preconception health may have important downstream benefits for their children, although more research is needed to replicate these findings.